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CGA Bar and Tavern Insurance Quote Request
We would like to provide you with a free, no-obligation quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Submitting Information
Business Name:
Contact Name:
Street Address:
City:   State:   ZIP:
County:   Email:
Business Phone: Fax:

Application Information Section
Name:
Title:
Business Name:
Street Address:
City:   State:   ZIP:
Type of Corporation:
Email:
Business Phone: Fax:

Nature of Business Section
Type of Business :
Years in Business:
Please describe your Business/Operations:  

Name that Appears
on the Liquor License:


Premises Information Section
Location Number:
Location Address:
City:
State:
Zip:

Property Coverage Section
  Limits Co Insurance Valuation Deductible
Building Limits:
Personal Property:
Loss of Rents:
Construction Type:
 # of Stories:
 Year Built:  
Is the Building Sprinklered?    Yes   No
Any Building Improvements?  Yes   No
If yes, please describe:

Liability Section
(Choose the limit options compatible with the program you are requesting)
General Aggregate Limit:   (By Choosing the Split Limit, the system will automatically generate)
Each Occurrence Limit:   

Liability Rating Section
Is your operation Seasonal?   Yes   No
If Yes, give dates: from: to:  
This section will touch on the gross receipts of the Bar / Tavern to determine the rating of the account:  
Liquor Sales:  
Food Sales:   
Do you have a Dance Floor? Yes    No    
Yes, how big is the floor :  
Do you provide Entertainment ? Yes  No  
If Yes, Please describe:  

Please note that in the amount section you will enter in the premium basis amount which could be one of the following: (P) Payroll , (S) Gross Sales, (A) Area, (U) Unit, (M) Admissions

 

Please advise:   Within the past five years has the applicant been cited by the Liquor Control Commission?  If  Yes, please describe:

 

 


Prior Policy/Loss History
Previous Carrier:     Policy Number:
Any Losses?   Yes   No
If yes, please describe:

 
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